I am a physician with long-standing interests in health policy, medical ethics and free-market economics. I am the co-founder of Freedom and Individual Rights in Medicine (FIRM). I graduated from University of Michigan Medical School and completed my residency in diagnostic radiology at the Washington University School of Medicine in St. Louis (where I was also a faculty member). I'm now in private practice in the Denver area. All my opinions are my own, and not necessarily shared by my employer.

Big Brother Has A New Face, And It's Your Boss

Recently, the CVS Caremark Corporation began requiring employees to disclose personal health information (including weight, blood pressure, and body fat levels) or else pay an annual $600 fine. Workers must make this information available to the company’s employee “Wellness Program” and sign a form stating that they’re doing so voluntarily.

CVS argues this will help workers “take more responsibility for improving their health.” At one level, this makes a certain sense. Because the company is paying for their employees’ health insurance, they naturally prefer healthier workers. But at a deeper level, CVS’ action demonstrates a growing problem with our current system of employer-provided health insurance. If our bosses must pay for our health care, they will inevitably seek greater control over our lifestyles.

Although most Americans take it for granted that they receive health insurance through the workplace, this is an artifact of federal tax rules from World War II. When the U.S. government imposed wartime wage controls, employers could no longer compete for workers by offering higher salaries. Instead, they competed by offering more generous fringe benefits such as health insurance. In 1943, the IRS ruled that employees did not have to pay tax on health benefits provided by employers; in 1954, the IRS made this permanent.

The federal government thus distorted the health insurance market in favor of employer-based plans. If a company paid $100 for health insurance with pre-tax dollars, the employee enjoyed the full benefit. But if the employee received that $100 as salary, he could only purchase $50-70 of insurance after taxes. Over time, this tax disparity helped employer-based health insurance dominate the private insurance market. In 2008, over 90% of non-elderly Americans with private insurance received it through their workplace.

Hence, government policy artificially injects the employer into the relationship between a patient and the health insurance system. Normally, what a worker ate or whether he smoked at home would be of no concern to his boss (unless it affected job performance). But U.S. government policy makes it the employer’s business.

To make matters worse, ObamaCare reinforces this status quo. ObamaCare requires large employers to offer health insurance to workers (or else pay a penalty). As a result, more people are discussing how best to link employment to healthy behavior. For example, the New England Journal of Medicine recently featured a pair of high-profile editorials debating the merits of allowing companies to discriminate against smokers, “for their own good.”

Furthermore, ObamaCare pays government grants to encourage companies to implement these “wellness programs.” Hence, employers who wouldn’t otherwise concern themselves with workers’ lifestyles now have an incentive to do so in order to collect federal funds.

Note that the issue of employers controlling employee lifestyles arises because the government artificially couples employment with health insurance. In contrast, we don’t receive automobile insurance or homeowner’s insurance through our jobs. Hence, most employers don’t care about employees’ driving records or the number of smoke detectors in their houses. There are no “safe driver” workplace programs along the lines of “employee wellness programs.”

This is the flip side of coupling health insurance to employment. Some employers (like Regal Cinema) are cutting back on worker hours to reduce those insurance costs. Others will still cover their employees — but will want to monitor those employees’ health and activities.

Instead of reinforcing the current system linking health insurance to employment, we should uncouple the two. We should equalize the tax status of employer-provided health insurance with insurance purchased by individuals outside of work. This is a key element of many free-market health reform plans (such as Docs4PatientCare.org “Prescription for Health Care Reform”). This would also help create a robust market for truly portable insurance that stayed with the customer when he changed jobs (just as one’s auto or homeowners insurance is unaffected by job changes).

As a physician, I encourage everyone to adopt a healthy lifestyle, including proper diet and exercise. It’s also entirely appropriate for insurance companies to charge higher rates for customers who smoke or engage in other unhealthy activities. Likewise, employers and workers should be free to voluntarily agree to contract terms that include incentives for healthy behavior, provided it’s without government nudging.

But it’s wrong for the government to use economic carrots and sticks to induce private employers to become enforcers of healthy behavior. This is just a subtler form of “nanny state” controls, such as NYC mayor Michael Bloomberg outlawing soft drinks he considers unhealthy. And once employers start monitoring employee behavior on the grounds of “health costs,” there’s no end to the potential meddling. Who will be the next politically disfavored group after smokers or the obese? Do we want bosses discouraging their employees from owning guns or enjoying mountain biking on the weekends? This is a dangerous road.

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certainly Hitler’s dictatorship is all in place so the govt. will have total control. this has been happening for years and now it surfaces full force and escalating like sheep being lead to slaughter.

And here is the actual goal of the liberal left. Force companies to 1) be your data miners, 2) go bankrupt insuring previous conditions, or 3) pay fines. No matter what, liberty dies and government grows. If the companies choose either of the latter two options, you get more dependency among citizens on the government insurance rosters, which punishes everyone who actually pays taxes. If they gather and submit data, government now has invaded your rights of privacy.

It is pretty much that way everywhere. Although I live in marxist paradise Washington State. But the despots are really getting bloated egos everywhere anymore. From the media, to entertainment, to schools, unions, medical facilities, & the very worst of the worst government workers. These people are so used to us not fighting anything that they simply take everything away from us by habit now.

America right now is on a course for massive decline. I have to laugh at forbes when it tries to predict a rosey future. The American People today will literally lay down & die before we limit even the slightest bit of tyranny over us. We will pay the government more, to give itself another party on our expense.

The American People have lost the ability to stop their government from destroying America.

Big Brother is going to be getting to be in increasingly more places. & he is insane, vicious & has an ego the size of the sun right now.

To further decline, the right does nothing to recover freedom. As if Americans don’t even want it anymore. & by that I mean that there is no recovery effort for the original independent way of life underway. The right sits & waits to die too.

I see a very foolish government, and an even more foolish employer community already struggling with their bad habits of greed and employee abuse. This is a dangerous game being played by Uncle Sam and America’s Employers.

We all forget two very important facts in this.

One is that lawyers will have a field day with “discrimination” cases. Along with lawsuits, as the NLRB continues on its path, more and more unions and employment regulations will sprout up to counter the bad habits of employers. Then where will the employers be? Did this not lead to unionization in the first place?

Two, Obamacare is already collapsing under its own weight as we speak. In a few years, we may not even have Obamacare. If it is not delivered as promised, the 2014 elections could spell doom for incumbent politicians, especially those who sold this piece of garbage legislation to this country.

In the meantime, as government and employers keep pushing and pushing, both may end up with a population based customer and employee rebellion on their hands. Already a few businesses are beginning to learn that greed has a high price tag. What will employers do when they reach the point, like Walmart seems to be doing now, where no one will apply for the jobs they offer? What will happen to inventory? How will that affect customers who want but cannot buy?

As much as employers and government would like the population to be dumb and stupid, they really are not. Every person who walks into a business can tell what the atmosphere is. For customers, it begins at the shelves of merchandise and the salesperson. For prospective employees, the HR Department is the first impression of the company they will see.

The days of abusing employees may very well be over soon. I know of several businesses just in our local area that have such bad reputations in the employment market that (1) they cannot keep the employees they have, and (2) they cannot find “qualified” applicants for their jobs…in the medical industry. High turnover rates and large employee vacancies in business can be more dangerous than unions. Both can and do destroy profit and business existence.

The more we turn employees over to the social welfare programs, the harder it will be for employers. As we are continuing to create this nanny state we already have, fewer people will want to toil for their food. Better to let the state feed them while they sit around at home.

If nothing else, this current economic environment has brought out the mismanagement and corporate stupidity of greed like never before. I thank the Lord every day that was smart enough to sell my business in 2008, and that I am retired now.

I have often said that the current Administration is the most dangerous this country has ever had. I also understand that over taxation, over regulation and excessive intrusion by government and employer, alike, are the end of all things “American” in this country.

Those businesses that have left this country won’t be back. Why should they? Those that have stayed will continue to dwindle and die under this administration. Businesses must start looking at their reputations in the employee marketplace as much as they look at their customer reputation. They are intertwined and cannot be separated. If bad, both can be killers separately, or together.

Obamacare was a disaster at its inception and passage. It still is. Obama and the Democrats own Obamacare. The Republicans own it, too. While they did not pass the bill, they failed to see the truth and prevent the legislation from becoming law. Now, every single American, and every single business left in America are feeling the political lies and incompetence.